Prognostic value of pretreatment prognostic nutritional index in intravenous immunoglobulin-resistant Kawasaki disease

Li, Gang; Xu, Xiumei; Chen, Pengyuan; Zeng, Rumeng; Liu, Bin

doi:10.1007/s00380-021-01819-w

Cited by 14 publications

(18 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, a high SII after treatment was found to be significantly associated with IVIG resistance but not CAA development, which is consistent with the results of Liu et al [22] but not of Rumeysa et al [19], possibly because of the different days of detection of illness onset. Interestingly, our study found that patients with KD had a lower PNI, which is an index for nutritional assessment, both in the IVIG-resistant and CAA groups when compared to their respective counterparts, as in several previous studies [15][16][17][18][19]. It is worth noting that the lowest PNI value in the IVIG-resistant group occurred on day 6, which corresponds to the highest SII value in the present study (Supplementary Fig.…”

Section: Discussionsupporting

confidence: 87%

“…Studies have discovered that among high-risk patients for initial IVIG resistance, the incidence of adverse coronary artery outcomes has been significantly reduced by adding corticosteroids or cyclosporine to standard-dose IVIG and aspirin in the primary treatment of KD [13,14]; therefore, studies are necessary to uncover novel parameters in the prediction of IVIG resistance among patients with KD. Given that a single risk factor for IVIG resistance is not necessarily transferable among populations, parameters merging the risk factors, such as the prognostic nutritional index (PNI) and systemic immune-inflammation index (SII), were correlated with increased incidence of IVIG resistance and CAA development and may have better discriminatory ability than any indicator alone, as reported in the past two years [15][16][17][18][19][20]; nevertheless, these results remain controversial. Moreover, most studies used data acquired before IVIG treatment, and few studies have included laboratory data both before and after treatment and taken into consideration the dynamic changes in these predictors.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of laboratory predictors for intravenous immunoglobulin resistance and coronary artery aneurysm in Kawasaki Disease before and after therapy

Liu

et al. 2022

Clin Rheumatol

View full text Add to dashboard Cite

Objectives We aimed to evaluate the clinical and laboratory characteristics of patients with Kawasaki disease (KD) before and after therapy. Methods Patients with KD were divided into different groups according to their responsiveness to initial intravenous immunoglobulin (IVIG) treatment and coronary status. The clinical and laboratory parameters before and after therapy were compared. Multivariate analysis was performed to identify the independent risk factors, and the receiver operating characteristic (ROC) curve was applied to assess and compare the prediction ability of risk factors and their fluctuations. Results Of the 153 patients included in the study, 41 (26.8%) had IVIG resistance and 37 (24.2%) had developed CAA. After stratifying by therapy response, the two groups differed in the levels of total bilirubin (TSB), albumin, and sodium, neutrophil-to-lymphocyte count ratio (NLR), platelet-to-lymphocyte count ratio (PLR), TSB-to-albumin (B/A) ratio, and prognostic nutritional index (PNI) before IVIG, and in the white blood cell count (WBC), neutrophil count, levels of hemoglobin, C-reactive protein (CRP), alanine aminotransferase (ALT), and albumin, NLR, PNI, capillary leakage index (CLI), and systemic immune-inflammation index (SII) after IVIG. Multivariate analysis revealed that the B/A ratio before IVIG and CLI and SII after IVIG were significantly and positively associated with IVIG resistance and that there was a larger decline in the B/A ratio and smaller decline in CLI and SII pre- and post-treatment in the IVIG-resistant group than in the IVIG-responsive group. However, no statistical differences in the fluctuations of the B/A ratio, CLI, and SII as well as all parameters before and after therapy were observed in patients with and without CAA. ROC curve analyses found a greater AUC value of post-treatment parameters (0.751 and 0.706 for CLI and SII, respectively) compared with pre-treatment parameters (0.654 for B/A ratio) in predicting IVIG resistance; however, the predictive ability of the fluctuations in risk factors before and after therapy was not superior to that of baseline values. Conclusions The B/A ratio before IVIG and CLI and SII after IVIG were risk factors for IVIG resistance in patients with KD, independent of CAA development. Key Points• A high total bilirubin-to-albumin ratio before IVIG and high capillary leakage and systemic immune-inflammation indices after IVIG may indicate an increased risk of intravenous immunoglobulin resistance in patients with Kawasaki disease.• Post-treatment parameters were superior to pre-treatment parameters in terms of prediction; therefore, rapid and repeated assessment of risk factors before and after treatment must be considered in children in whom the vital signs and symptoms do not improve after treatment.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Evaluation of laboratory predictors for intravenous immunoglobulin resistance and coronary artery aneurysm in Kawasaki Disease before and after therapy

Liu

et al. 2022

Clin Rheumatol

View full text Add to dashboard Cite

show abstract

“…It can also predict the clinical outcomes of pediatric patients after cardiac surgical procedures (54)(55)(56)(57). Moreover, PNI is known to be used as an adjunctive predictor of IVIG resistance and CAA development in patients with KD, which has been confirmed by previous studies in the last 2 years (19)(20)(21)(22)(23). Unfortunately, in the present study, we could not find significant differences between the subgroups based on the coronary status in terms of PNI.…”

Section: Discussionsupporting

confidence: 75%

“…Recently, the prognostic nutritional index (PNI), based on a combination of albumin levels and peripheral blood lymphocyte count, has been associated with the nutritional, immunological, and inflammatory statuses of the body (17,18). Several studies have associated a low pre-treatment PNI with a high incidence of CALs and IVIG resistance in patients with KD (19)(20)(21)(22)(23); however, the association between nutritional status and PNI in relation to CAA regression remains elusive. Therefore, the present study was designed to determine whether the PNI could predict persistent CAA in patients with KD.…”

Section: Introductionmentioning

confidence: 99%

Prognostic nutritional index value in the prognosis of Kawasaki disease with coronary artery lesions

Liu

Yuan

et al. 2023

Front. Nutr.

View full text Add to dashboard Cite

ObjectivesThe prognostic nutritional index (PNI) is a purported predictor of intravenous immunoglobulin (IVIG) resistance and coronary artery aneurysm (CAA) development in patients with Kawasaki disease (KD). However, limited data exist on CAA regression. This study aimed to confirm whether the PNI is a predictor for CAA persistency in patients with KD.MethodsThis retrospective study grouped 341 patients with KD based on the coronary artery status and time of aneurysm persistence. The clinical and laboratory parameters were compared, and multivariate logistic regression analysis was performed to identify the independent risk factors for persistent CAA. The receiver operating characteristic (ROC) curve was further used to assess the predictive values of the PNI in persistent CAA.ResultsAmong the study patients, 80 (23.5%) presented with CAA, including CAA persisting for 2 years in 17 patients (5.0%). Patients with CAA were more frequently treated with corticosteroids (p < 0.016). No statistically significant differences were found in the nutritional status and PNI among patients with or without coronary artery lesions, regardless of injury severity. Patients in the persistent CAA group presented with higher rates of overnutrition and showed lower PNI values and a higher incidence of thrombosis than those in the normal group (p < 0.05). The PNI and the maximum Z-score at 1 month of onset were significantly associated with CAA persisting for 2 years and may be used as predictors of persistent CAA. The area under the ROC curve was 0.708 (95% confidence interval, 0.569–0.847), and a 40.2 PNI cutoff yielded a sensitivity and specificity of 41 and 92%, respectively, for predicting CAA persisting for 2 years. Kaplan–Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in patients with PNI values of ≤40 than in those with PNI values of >40 (hazard ratio, 2.958; 95% confidence interval, 1.601–5.464; p = 0.007). After sampling-time stratification, the PNI differed significantly between patients with and without persistent CAA when sampled on the second (p = 0.040), third (p = 0.028), and fourth days (p = 0.041) following disease onset.ConclusionA lower PNI value is an independent risk factor for CAA persisting for 2 years in patients with KD, besides the maximum Z-score at 1 month after onset. Furthermore, the PNI obtained within 4 days from fever onset may possess greater predictive power for patients with persistent CAA.

show abstract

“…The PNI has been reported to be a strong indicator for predicting the prognosis of patients with malignant tumors and has been widely used in predicting the prognosis, postoperative complications, and quality of life of a variety of tumors [ 27 , 28 ]. The PNI was found to be a novel surrogate independent predictor for IVIG-resistant KD according to a recent study [ 29 ]. In KD patients, the ALB levels were significantly lower than those of the febrile control group and even lower in KD with CAL formation [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Complement 3 and the Prognostic Nutritional Index Distinguish Kawasaki Disease from Other Fever Illness with a Nomogram

Huang

Xia

et al. 2021

Children

View full text Add to dashboard Cite

Objective: This study aimed to establish a model to distinguish Kawasaki disease (KD) from other fever illness using the prognostic nutritional index (PNI) and immunological factors. Method: We enrolled a total of 692 patients (including 198 with KD and 494 children with febrile diseases). Of those, 415 patients were selected to be the training group and 277 patients to be the validation group. Laboratory data, including the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the prognostic nutritional index (PNI), and immunological factors, were retrospectively collected for an analysis after admission. We used univariate and multivariate logistic regressions and nomograms for the analysis. Result: Patients with KD showed significantly higher C3 and a lower PNI. After a multivariate logistic regression, the total leukocyte count, PNI, C3, and NLR showed a significance (p < 0.05) and then performed well with the nomogram model. The areas under the ROC in the training group and the validation group were 0.858 and 0.825, respectively. The calibration curves of the two groups for the probability of KD showed a near agreement to the actual probability. Conclusions: Compared with children with febrile diseases, patients with KD showed increased C3 and a decreased nutritional index of the PNI. The nomogram established with these factors could effectively identify KD from febrile illness in children.

show abstract

Prognostic value of pretreatment prognostic nutritional index in intravenous immunoglobulin-resistant Kawasaki disease

Cited by 14 publications

References 40 publications

Evaluation of laboratory predictors for intravenous immunoglobulin resistance and coronary artery aneurysm in Kawasaki Disease before and after therapy

Evaluation of laboratory predictors for intravenous immunoglobulin resistance and coronary artery aneurysm in Kawasaki Disease before and after therapy

Prognostic nutritional index value in the prognosis of Kawasaki disease with coronary artery lesions

Complement 3 and the Prognostic Nutritional Index Distinguish Kawasaki Disease from Other Fever Illness with a Nomogram

Contact Info

Product

Resources

About